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Last year, the Food and Drug Administration (FDA) approved the first whole slide imaging system for digital pathology, which opened a new door for the technology to advance.

To capitalize on this “watershed moment,” as one expert described it during a session at the Society for Imaging Informatics in Medicine (SIIM) 2018 annual meeting in National Harbor, Maryland, pathology must join with radiology—a leader in adopting new technologies—to realize the true potential of digital pathology.

“If we don’t partner with radiology—meaning pathology imaging—then we’re going to have a tough battle to create the infrastructure, use cases and solve the issues … that radiology has largely solved,” said Michael J. Becich, MD, PhD, the chairman of the department of biomedical informatics at the University of Pittsburgh Medical Center, during the session. “Pathology needs radiology more than it ever has because of the FDA approval.”

Why can’t we search?

Pathology is different from radiology in many ways, but they share common goals. But one in particular, Becich believes, could help the pair “rule” healthcare and informatics.

“Search is what is wrong with healthcare and our system today,” he said. “We cannot search with the tools we have.”

Just as you can easily find every movie starring Tom Cruise, an imaging professional should be able to search for a unique lesion in an information system and pull up results showing how many times it has appeared before—and what the outcomes were in a specific setting—to help guide proper treatment, Becich explained.

This will require a new way of thinking about billing systems, information architecture and the input of information-rich imaging metadata into workflows—a task neither radiology nor pathology can handle alone.

But there will always be resistance to change.

Fellow panelist Eric Glassy, MD, a board member at the College of American Pathology, brought up a recent call with a Boston company with a goal to create a central database for all radiology and pathology imaging data that would track each instance of care related to individual pathology or radiology results.

“I would think this would be something pathologists would embrace, but when I brought it up to some colleagues there was some pushback that surprised me,” he said.

At least one of Glassy’s colleagues was concerned cases would be overread. For example, if a lesion was diagnosed as harmless, but two years later found to be melanoma, there could be a potential for lawsuits.

“I would hope we would collectively support the value of the patient, not the attorney fees,” he remarked.

Humility goes a long way

How can radiology team up with pathology to overcome challenges and accomplish these lofty ideas?

Rasu Shrestha, MD, chief innovation officer and executive vice president of the University of Pittsburgh Medical Center Enterprises, believes it starts with understanding limitations.

“I do believe it’s important for us not to profess we know everything,” he said.

In recent years, Shrestha has heard of pushback from pathologists when those from other specialties believe they understand the challenges in digital pathology and claim to hold the answers.

“Let’s enable those workflows to happen, but perhaps the focus should be to turn it around and find specific areas where we can add a lot of value … but remember that we’re doing this hand-in-hand,” Shrestha said.

After all, it’s about what benefits the patient most—and they don’t care what kind of ‘ologist you are.

“Patients could care less what specialty you are, they want to know what’s wrong with them and be educated on their journey,” Shrestha said.

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